CAM 70134

Electrocorticography

Category:Surgery   Last Reviewed:March 2019
Department(s):Medical Affairs   Next Review:March 2999
Original Date:March 1996    

Description:
Electrocorticography (ECoG) uses epidural or subdural electrode arrays to record the electroencephalogram (EEG) from the cerebral cortex. ECoG is an invasive procedure; a craniotomy is required for implantation of the electrodes. The purpose of ECoG is to localize a suspected seizure focus in the cerebral cortex in patients who are candidates for surgery.

Policy:
Extraoperative electrocorticography is considered MEDICALLY NECESSARY on a prior approval basis for the purpose of recording seizures. Prior to undergoing ECoG:

  • The patient must have debilitating seizures intractable to anticonvulsant medication.
  • The patient must have undergone standard testing that does not clearly localize a seizure focus but does indicate strongly the presence of a focus.
  • The suspected seizure focus must be in an area of the brain that is accessible for surgery.

Extraoperative ECoG is considered INVESTIGATIONAL for stimulation and recording in order to determine electrical thresholds of neurons as an indicator of seizure focus.      

Benefit Application
BlueCard®/National Account Issues
Intraoperative ECoG is a longstanding technique used to map abnormal brain tissue in the motor and/or sensory cortex prior to resection of the abnormal tissue. As such, intraoperative ECoG is an integral part of the surgical procedure and is not eligible for coverage as a separate procedure.

For the purposes of concurrent review, high frequency of recording sessions or long duration of implantation may indicate that the ECoG is being used for stimulation and recording to determine neuronal thresholds. EEGs that result from such sessions may show stimulation artifacts that would not occur if EEG recording was performed without stimulation. However, such stimulation artifacts can be filtered out in the recording process and, therefore, will not always be evident in the EEG.

References:

  1. Davies, K. G., & Weeks, R. D. (1993). Cortical resections for intractable epilepsy of extratemporal origin: Experience with seventeen cases over eleven years. British Journal of Neurosurgery, 7 (4), 343-353.
  2. Gomez, U. E., Sanchez, A. A., Alijarde, M. T., & Navarrete, E. G. (2001). Prognostic value of electrocorticography in temporal lobe epilepsy: Patterns of relationing mesial and neocortical activity. Revista de Neurologia, 33 (9), 801-808.
  3. Osorio, I., Frei, M. G., Giftakis, J., Peters, T., Ingram, J., Turnbull, M., et al. (2002). Performance reassessment of a real-time seizure-detection algorithm on long EcoG series. Epilepsia, 43 (12), 1522-1535.

Coding Section

Codes Number Description
CPT 61533 Craniotomy with elevation bone flap; for subdural implantation of an electrode array, for long-term monitoring
  95950-95954 EEG code range
ICD-9 Procedure 02.93 Implantation of intracranial neurostimulator (includes depth electrodes)
  89.14 Electroencephalogram
ICD-9 Diagnosis 345.00-345.91 Epilepsy code range
  780.3 Convulsions
HCPCS A4556 Electrode
ICD-10-CM (effective 10/01/15)  G40309  Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus 
  G40311  Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus 
  G40301 Generalized idiopathic epilepsy and epileptic syndromes, not intractable, with status epilepticus 
  G40201  Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, with status epilepticus
  G40209  Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus 
  G40211  Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus 
  G40219  Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus 
  G40101  Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, with status epilepticus 
  G40109  Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, without status epilepticus 
  G40111  Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus 
  G40119  Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus 
  G40401  Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus 
  G40409  Other generalized epilepsy and epileptic syndromes, not intractable, without status epilepticus 
  G40411  Other generalized epilepsy and epileptic syndromes, intractable, with status epilepticus 
  G40419  Other generalized epilepsy and epileptic syndromes, intractable, without status epilepticus 
  G40501  Epileptic seizures related to external causes, not intractable, with status epilepticus 
  G40509  Epileptic seizures related to external causes, not intractable, without status epilepticus 
  G40802  Other epilepsy, not intractable, without status epilepticus 
  G40804 Other epilepsy, intractable, without status epilepticus 
  G40901  Epilepsy, unspecified, not intractable, with status epilepticus 
  G40909  Epilepsy, unspecified, not intractable, without status epilepticus 
  G40911  Epilepsy, unspecified, intractable, with status epilepticus 
  G40919  Epilepsy, unspecified, intractable, without status epilepticus 
  R5600 Simple febrile convulsions 
  R5601  Complex febrile convulsions 
  R561  Post traumatic seizures 
  R569  Unspecified convulsions 
ICD-10-PCS (effective 10/01/15)  00H00MZ  Insertion of Neurostimulator Lead into Brain, Open Approach
  00H03MZ  Insertion of Neurostimulator Lead into Brain, Percutaneous Approach 
  00H04MZ  Insertion of Neurostimulator Lead into Brain, Percutaneous Endoscopic Approach 
  00H60MZ  Insertion of Neurostimulator Lead into Cerebral Ventricle, Open Approach 
  00H63MZ  Insertion of Neurostimulator Lead into Cerebral Ventricle, Percutaneous Approach 
  00H64MZ Insertion of Neurostimulator Lead into Cerebral Ventricle, Percutaneous Endoscopic Approach 
  4A0034Z  Measurement of Central Nervous Electrical Activity, Percutaneous Approach 
  4A00X4Z  Measurement of Central Nervous Electrical Activity, External Approach 
  4A0134Z  Measurement of Peripheral Nervous Electrical Activity, Percutaneous Approach 
  4A01X4Z  Measurement of Peripheral Nervous Electrical Activity, External Approach 
  4A1034Z  Monitoring of Central Nervous Electrical Activity, Percutaneous Approach 
  4A10X4Z  Monitoring of Central Nervous Electrical Activity, External Approach 
  4A1134Z  Monitoring of Peripheral Nervous Electrical Activity, Percutaneous Approach 
  4A11X4Z  Monitoring of Peripheral Nervous Electrical Activity, External Approach 
Type of Service Surgery  
Place of Service Inpatient  

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross and Blue Shield Association technology assessment program (TEC) and other non-affiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

"Current Procedural Terminology© American Medical Association.  All Rights Reserved" 

History From 2014 Forward     

03/04/2019 

Annual review, no change to policy intent. 

03/19/2018 

Annual Review. No change to policy intent. 

03/01/2017 

Annual review.  No change to policy intent 

03/09/2016 

Annual review. No change to policy intent. 

09/21/2015 

Added ICD-10 codes to policy. 

03/05/2015 

Annual review. Added coding. No change to policy intent.

03/4/2014

Annual review. No changes made.


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